Flashcards in Liver test 2 Deck (149):
What do you have to show when you sweep through the liver?
left, right and caudate lobe
What is the largest parenchymal organ in the body?
Where is the liver found?
in the peritoneum
The liver is a chemical factory? true or false
What is the parenchyma?
the texture of the liver tissue
Renal cortex is ____ echogenic than the liver
Renal sinus is ______compared to the liver and to the renal cortex
Renal cortex is _______ compared to the liver
What organ is similar to the liver in echotexture?
make sure you label!!
what is more echogenic than the liver or the spleen?
the Pancreas (gets brighter as you age)
What is anterior to the portal confluence and splenic vein?
What is the normal size of the liver?
typically 18 cm (anything between 15-18cm)
What part of the body does the liver occupy?
What covers the liver?
Where does the stomach lie in comparison to the liver?
stomach lies posterior and lateral to the left lobe
if confusion about a mass or stomach...will have parastalisis if its stomach
What lies adjacent to the liver?
What is posterior to the liver?
What is the superior border of the liver?
What is the liver suspended by?
the falciform ligament
What mostly covers the liver?
What is the bare area of the liver?
the area on the posterosuperior (diaphragmatic) surface of the liver
bordered by the coronary ligament but itself devoid of peritoneum
the diaphragm and liver lie in direct contact and adhere
What is the space between liver and kidney?
subphrenic space or morison's pouch
Where does fluid accumulation or abscess accumlate around the liver?
subphrenic space (aka morison's pouch)
If you see fluid in Morison's pouch what do you do?
a four quadrant sweep
What is the largest lobe of the liver?
What is a fossa?
an impression of where something lives
What are the fossa's of the liver?
What is reidel's lobe?
a congenital variant
an anterior projection on the right lobe
How does Reidel clinically present?
Where is the left lobe of the liver found?
epigastric and left hypochondriac
What impression is under the left lobe?
the gastric impression
What is the medial segment of the left lobe??
Where is the quadrate lobe found?
posterioinferior Lt. lobe
bounded by GB fossa, porta hepatis and umbilical vein fossa
What is the caudate lobe?
posterior portion of the liver
What separates the caudate lobe from the left lobe?
Of Couinaud's 8 segments of the liver, what is segment two?
lateral left lobe (superior)
What is segment I of couinaud's surgical resection of the liver?
Who is Couinaud?
Created the surgical resection of the liver with 8 segments
What are the segments based on?
what we see of the portal and hepatic veins
how do ligaments and fissures appear on US?
appear echogenic or hyperechoic because of the presence of collagen and fat within and around the structures
What are the ligament and fissures?
main lobar fissure
ligamentum teres (round ligament)
What is glisson's capsule
thin connective tissue
thickest around the IVC and porta hepatis
what is the main lobar fissure?
boundary between right and left lobes
hyper echoic line from portal vein to GB
picture slide 32
What is the falciform ligament?
helps attach liver to diaphragm
formed from mid-portion of coronary ligament
inferior margin contains ligamentum teres
What is the ligamentum teres?
dividing the medial and lateral left lobe
circular echogenic structure
Why is the ligamentum teres special?
remnant of umbilical vein (belly button to placenta)
potential to recanalize - (when there is portal HTN it can pop open and make it a vein again. cirrhosis can cause this too)
What is the ligamentum venosum a remnant of?
thin echogenic line anterior to the caudate lobe
Where is the right intersegmental fissure?
the RHV lays in this fissure
dividing anterior and posterior
Where is the left intersegmental fissure?
the LHV lays in this fissure
divides left lobe into medial and lateral
What are the coronary and triangular ligaments?
suspends the liver from the diaphragm
Has NOTHING to with the heart
What size does the portal vein need to be to be normal?
< 13mm in AP
How does the RPV course through the liver?
courses laterally and posteriorly
splits into anterior and posterior branches
What does an enlarged portal vein indicate?
do the IVC and the MPV ever connect?
what are the two kinds of liver cells?
What do hepatocytes do?
What do the kupffer cells do?
What is one thing we use the liver for in US?
to evaluate other organs
where would we find the pancreas in relation to the liver?
seen just inferior to the left lobe
what area of the body does the right lobe of the liver occupy?
the right hypochondrium
Is Reidel's lobe more common in men or women?
What is the texture of Reidel's lobe?
Reidel's lobe is an elongation of which segment?
What is the caudate lobe bounded by?
ductus venosus fossa
What is segment III of Couinaud's liver resection?
lateral left lobe - inferior
What is segment IV of Couinaud's liver resection?
medial segment of the left quadrate
What is segment V of Couinaud's liver resection?
anterior inferior segment of the right lobe
What is segment VI of Couinaud's surgical liver resection?
posterior segment of the right lobe - inferior
What is segment VII of couinaud's liver resection?
posterior superior segment of the right lobe
What is segment VIII of Couinaud's liver resection?
superior anterior segment of the right lobe
What separates the caudate lobe from the left lobe?
What does the hepatic artery do?
carries oxygenated blood from the aorta to the liver
how much oxygen does the hepatic artery supply to the liver?
Is the hepatic artery high or low resistance?
how does the main portal vein enter the liver?
at the hilum
through the porta hepatis
Between the LT and RT portal vein, which is the larger branch?
The Right portal vein
Between the Rt and LT portal vein, which one is more anterior?
The LT portal vein
How does the LPV course through the liver?
splits into medial and lateral branches
What supplies >60% of the blood supply to the liver?
the portal vein
Is the portal vein higher or lower in oxygen?
What does the main portal vein branch into?
the LT and RT portal veins
What is it called as the PV enters the center of the liver and the lobes that are supplied?
Of the hepatic veins, which is the largest?
RT hepatic vein
of the hepatic veins, which is the smallest?
Left hepatic vein
Where do the hepatic veins enter the IVC?
below the diaphragm
What do the hepatic veins do?
drain blood from the liver and return it to the heart
What is the job of the RHV?
drains the right lobe
divides RT lobe into anterior and posterior segments
lies in RT segmental fissure in longitudinal plane
What is the job of the MHV?
separates right and left lobes
lies in main lobar fissure in trv plane
What is the job of the LHV?
drains left lobe
divides left lobe into medial and lateral segments
lies in left segmental fissure in trv plane
The portal vein carries blood from the ______ to the _____
The hepatic veins drain blood from the ______ into the _____.
What are the main aspects of the portal veins?
SV joins SMV to form PV
Larger at their orgin
branches point to the porta hepatis
traverse the lobes
What are the main aspects of the hepatic veins?
flow into the IVC
course between the lobes
larger as they drain into the IVC
branches point to the diaphragm
multi phasic doppler
What is the job of the hepatobiliary system?
metabolic - chemical reactions to sustain life
excretory - elimination of waste products of metabolism
What makes up the hepatobiliary system?
Where do the bile ducts enter the duodenum?
through the ampulla of vater
what structures create the common bile duct?
bile canaliculi > interlobular ducts > RT and LT hepatic ducts > common hepatic duct + cystic duct = common bile duct
What are the liver functions?
synthesis and secretion of bile
what part of the liver are the functional units?
what do the outer margin of the lobules contain?
portal triad tracts
What do hepatocytes do?
What do Kupffer cells do?
aka: reticuloendothelial cells
phagocytize bacteria and foreign material
What is the job of the metabolizing physiology of the liver?
synthesizing complex substances into simple ones for energy
What are the metabolism enzymes that we need to know for liver lab values?
AST (aspartase aminotransferase)
ALT (alanine aminotransferase)
Alk Phos (alkaline phosphatase)
What in the lab values will tell you if you have a biliary obstruction?
AST and ALT mildly elevated
Alk Phos - marked elevation
Abn in metastatic
What will happen with the liver lab values if you have hepatocellular obstruction?
AST and ALT - striking elevation
ALT is more specific
What is hepatocellular disease?
liver cells (hepatocytes) are the immediate problem
usually treated medically with supportive measures and drugs
What is an obstructive disorder in liver disease?
bile excretion is blocked
usually treated surgically
If AST and ALT are elevated, what disease are you looking for?
heart and skeletal damage
If ALT is elevated above AST, what is the cause?
If Alk phos is elevated what are you looking for?
What is Alpha fetoprotein?
normally produced by the liver and yolk sac of a fetus
AFP levels decrease soon after birth
AFP probably has no normal function in adults
How does the GB aid in digestion?
Expels waste products
Bile is continuously formed and transported by ducts
release bilirubin when RBC are broken down
What does the liver store?
What organ eliminates Urea?
How is urea measured?
in the BUN (blood urea nitrogen lab value)
what might you have if the BUN is low?
severe liver disease
What is converted to urea?
What condition do you get when there is ammonium accumulation?
breath odor - fector hepaticus
What does the liver detox?
Bilirubin is the product of ______.
what is uptake?
when bilirubin separated from albumin
What is conjugation?
When bilirubin is combined with glucuronic acid...making it soluble in water
What is bile?
excretory product of the liver
What is formed continuously in the hepatocytes?
Bile _______ and is _________ in the ducts
What makes up bile?
What is the job of bile?
emulsification of fat
removal of wastes
What is a liver function test?
AST (formerly SGOT) aspartate aminotransferase
What is AST?
Enzyme present in tissue with high metabolism
When will you find elevated AST?
With any disease that injures liver cells
If you have significant elevations of AST, what conditions do you potentially have?
What does elevated bilirubin give you?
What is direct bilirubin?
elevated hepatocellular disease
elevated biliary obstruction
What is indirect bilirubin?
elevated hematologic disease
What happens if estrogen failures to metabolize due to liver disease?
gynecomastia (breast enlargement)
What is LDH?
lactic acid dehydrogenase
When does LDH elevate?
moderate elevation with infectious
When Does alk phos elevate?
good indicator of intrahepatic and extrahepatic OBSTRUCTION of the liver
What disturbs bilirubin?
What is related to the elevation of DIRECT bilirubin?
stone, mass, neoplasm
US "sees" the cause
What is prothrombin time (PT)?
show blood clotting
vitamin K (adds to blood clotting)
liver disease causes an increase in PT
What do albumin and globulin indicate in a liver function test?
FINISH SLIDE 93
What is hepatocellular diseases?
Directly effects the actual liver cells (hepatocytes)
What are obstructive diseases?
a 'something" is blocking part of the biliary tree
a mass, stone...something blocking
What are the indications for US of the liver?
hx of alcohol abuse
What is the prep for liver US?
NPO for 8 hours if GB is evaluated